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Women's Health > Pelvic Pains > Flashcards

Pelvic Pains Flashcards

1
Q

Dysmenorrhea

A

painful periods

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2
Q

Dyspareunia

A

pain with sex

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3
Q

Vulvadynia

A

pain of the vulva

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4
Q

Dyschezia

A

pain with bowel movements

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5
Q

Dysuria

A

pain with urination

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6
Q

Chronic pelvic pain

A

pelvic pain that has been present for > 6mo

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7
Q

When you think cyclic pain….

A

fibroids, endometriosis, adenomyosis

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8
Q

All lower abdominal pain warrants

A

a pelvic exam

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9
Q

1st test for evaluating pelvic pain?

A

Sonogram

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10
Q

What can a sonogram show us?

A

fibroids, infected (dilated) tubes, adnexal masses, blood in the abdomen

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11
Q

How is endometriosis diagnosed?

A

laparoscopy

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12
Q

What is usually a surgical emergency in ovarian masses?

A

6-10cm, ovarian torsion

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13
Q

boggy enlgarged tender uterus, progressively worsening painful and heavy periods, which gets better after two weeks

A

adenomyosis

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14
Q

What is adenomyosis?

A

extension of endometrial glands and stroma into the uterine muscle more than 2.5mm beneath the basalis layer

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15
Q

What is seen on a cut section in adenomyosis

A

not distinct margin between the adenomyoma and surrounding myometrium

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16
Q

How is adenomyosis diagnosed?

A

ultrasound and MRI (better, but cost more)

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17
Q

Conformational diagnosis of adenomyosis?

A

surgical, usually after a hysterectomy

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18
Q

What are leiomyomas

A

fibroids, benign, derived from smooth muscle cells of the myometrium

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19
Q

What is the most common uterine neoplasia, but has minimal chance for malignant transformation?

A

leiomyomas

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20
Q

Symptoms of leiomyomas?

A

most no symptoms

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21
Q

Large leiomyomas produce what type of symptoms

A

urinary symptoms or back pain, dysmenorrhea

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22
Q

Heavy or long periods are caused by what type of leiomyomas?

A

submucosal fibroid (even if small) or multiple intramural fibroids

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23
Q

What type of leiomyomas doesn’t likely cause heavy or long periods?

A

subserosal or pedunculated

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24
Q

Treatment for leiomyomas

A 
OCPs or Progesterone
GNRH agonist (temporary)
Myomectomy (to reserve fertility)
Hysterectomy
Uterine fibroid embolization
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25
Q

What is a functional cyst?

A

a follicle of at least 3cm

mobile, unilateral, and not associated w/ ascites

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26
Q

Symptoms of a functional cyst?

A

pelvic pain
dull sensation
heaviness in the pelvis

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27
Q

How is a functional cyst diagnosed?

A

when a 5-8cm cystic adnexal mass is noted on bimanual exam

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28
Q

How is a functional cyst confirmed?

A

lesion regresses over the course of the next several cycles

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29
Q

What is the treatment for a functional cyst?

A

OCP (low dose) to prevent another cyst

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30
Q

Huge size ovary, taking up the pelvis and abdomen

A

Mucionous Cystadenoma

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31
Q

Mucinous neoplasms are often..

A

benign tumors, multilocular and less than 10% bilateral

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32
Q

Benign cystic teratoma?

A

dermoid cyst

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33
Q

What is the most common ovarian neoplasm?

A

dermoid cyst

34
Q

Dermoid cyst are mostly composed of what?

A

ectodermal tissue that has.. sweat and sebaceous glands, hair follicles, teeth

35
Q

What age is likely to have a dermoid cyst?

A

25 and 50 yrs of age

36
Q

How big can a dermoid cyst get?

A

less than 10 cm in diameter

37
Q

Treatment for a symptomatic or large dermoid cyst?

A

surgical treatment (cystectomy vs. oophectomy)

38
Q

During treatment of a dermoid cyst what must be done?

A

the other ovary must be examined

39
Q

Most benign tumors of the fallopian tubes are

A

infectious or inflammatory (hydrosalpinx & pyosalpinx)

40
Q

How is a tubal neoplasm and a adnexal masses differentiated on exam?

A

operative exploration

41
Q

How is hydrosalpinx treated?

A

Salpingectomy

42
Q

To be a functional ovarian cyst it must be at least?

A

3 cm

43
Q

When should a cyst be referred to a gynecologist?

A

cyst persist after 6 weeks or more
patient is symptomatic
patient has a large cyst 10cm
ovarian torsion cannot be ruled out

44
Q

What is ovarian torsion?

A

complete or partial rotation of the ovary on its ligamentous support

45
Q

What is often seen in ovarian torsion?

A

impedance of its blood supply

46
Q

The most common gynecologic emergencies affecting females of all ages

A

Ovarian Torsion

47
Q

What is the most likely factor to predispose ovarian torsion?

A

ovarian functional cyst

48
Q

In ovarian torsion what does the ovary rotate around?

A

infundibulopelvic ligament and

utero-ovarian ligament

49
Q

As the size of the ovarian mass increases, the risk of torsion increases, until it becomes fixed in place at ….

A

5 cm or larger

50
Q

What causes the emergency in ovarian torsion?

A

loss ovarian function and necrosis

51
Q

Presentation of ovarian torsion?

A

acute onset of moderate to severe pelvic pain w/ n/v

52
Q

What does physical exam show in ovarian torsion?

A

consistent w/ tenderness to palpation (guarding, rebound)

53
Q

What imaging is used for ovarian torsion?

A

TVUS (lack of color blood flow)

54
Q

What is the treatment for a asymptotic or small cyst?

A

expectant management

observe (w/ no symptoms or pain)

55
Q

Cyst that develops in association w/ a high level of hCG

A

Theca-Lutein Cysts

56
Q

Ovarian Hyperstimulation Syndrome and theca-lutein cysts can be caused by?

A

a pt undergoing ovulation induction w/ gonadotropins or clomiphene

57
Q

Hydatidiform mole or choriocarcinoma may develop

A

theca-lutein cysts

58
Q

What is the treatment for theca-luthein cyst

A

discontinuation of medication as well as IV fluids and correction of electrolites

59
Q

Describe Theca-lutein cysts?

A

usually bilateral
quite large > 30cm
regress slowly after gonadotropin level falls

60
Q

Treatment for a molar pregnancy?

A

evacuation of uterine contents

Dilation and Curettage (D&C)

61
Q

T/F Theca Lutein cysts, once source of pregnancy hormone is removed, cysts will regress

A

TRUE

62
Q

What occurs due to a elevated BHCG hormone?

A

Theca-Luthein cysts

63
Q

T/F if pregnancy test is negative patient should not have a theca luthein cyst?

A

True

64
Q

Ruptured ovarian cyst is also referred as?

A

mittelschmerz

65
Q

Ruptured ovarian cyst is likely to occur in what women?

A

reproductive age and postmenopausal

66
Q

What is a risk factor for ovarian cyst rupture?

A

Vaginal intercourse

67
Q

What are methods to prevent rupture of a cyst?

A

NONE…except:

surgical drainage or removal of the cyst

68
Q

T/F Prevention of cyst rupture is a surgical indication

A

FALSE

69
Q

What treatments can suppress ovulation and prevent the development of a new cyst

A

OCP

70
Q

What is a classic presentation of a ruptured ovarian cyst?

A

sudden onset of severe sharp and focal unilateral lower quadrant pain, following sex and exercise

71
Q

Which ovary is most commonly ruptured?

A

Right

72
Q

What usually causes the pain due to a ruptured ovarian cyst

A

blood in the peritoneal cavity

73
Q

What do the vital signs in ovarian ruptured cyst look like?

A

normal, low grade fever

74
Q

What do the abdominal exam look like in ruptured ovarian cyst?

A

one side of the lower abdomen is tender

or rebound tenderness and over peritonitis

75
Q

What do the pelvic exam look like in ruptured ovarian cyst?

A

if not completely collapsed a adnexal mass may be palpable on bimanual exam
cervical motion tenderness

76
Q

What do labs look like in ruptured ovarian cyst?

A

a low hematocrit may be caused by hemorrhage

77
Q

What imaging is used to detect a ruptured ovarian cyst?

A

pelvic ultrasound

78
Q

What does a complicated ruptured ovarian cyst look like?

A

signs of hemodynamic instability, hypotension, tachycardia

79
Q

Treatment for a uncomplicated ruptured ovarian cyst?

A

observation

80
Q

Treatment for a complicated ruptured ovarian cyst?

A

inpatient observation or surgery

Women's Health (11 decks)

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